Objectives: The aim of this study was to evaluate the impact of coronary artery calcium (CAC) burden and regional distribution on the need for and type of future coronary revascularization-percutaneous versus surgical (coronary artery bypass graft [CABG])-among asymptomatic subjects.
Background: The need for coronary revascularization and the chosen mode of revascularization are thought to be functions of disease burden and anatomic distribution. The association between the baseline burden and regional distribution of CAC and the risk and type of future coronary revascularization remains unknown.
Methods: A total of 6,540 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) (subjects aged 45 to 84 years, free of known baseline cardiovascular disease) with vessel-specific CAC measurements were followed for a median of 8.5 years (interquartile range: 7.7 to 8.6 years). Annualized rates and multivariate-adjusted hazard ratios for revascularization and revascularization type were analyzed according to CAC score category, number of vessels with CAC (0 to 4, including the left main coronary artery), and involvement of individual coronary arteries.
Results: A total of 265 revascularizations (4.2%) occurred during follow-up, and 206 (78% of the total) were preceded by adjudicated symptoms. Revascularization was uncommon when CAC score was 0.0 (0.6%), with a graded increase over both rising CAC burden and increasingly diffuse CAC distribution. The revascularization rates per 1,000 person-years for CAC scores of 1 to 100, 101 to 400, and >400 were 4.9, 11.7, and 25.4, respectively; for 1, 2, 3, and 4 vessels with CAC, the rates were 3.0, 8.0, 16.1, and 24.8, respectively. In multivariate models adjusting for CAC score, the number of vessels with CAC remained predictive of revascularization and mode of revascularization. Independent predictors of CABG versus percutaneous coronary intervention included 3- or 4-vessel CAC, higher CAC burden, and involvement of the left main coronary artery. Risk for CABG was extremely low with <3-vessel baseline CAC. Results were similar when considering only symptom-driven revascularizations.
Conclusions: In this multiethnic cohort of asymptomatic subjects, baseline CAC was highly predictive of future coronary revascularization procedures, with measures of CAC burden and distribution each independently predicting need for percutaneous coronary intervention versus CABG over an 8.5-year follow-up.
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http://dx.doi.org/10.1016/j.jcmg.2014.03.005 | DOI Listing |
BMC Surg
December 2024
Department of Geriatric Medicine, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, 9 Jiaowei Road, Wenzhou city, Zhejiang Province, 325000, China.
Background: Coronary artery bypass grafting (CABG) remains the preferred treatment for complex multi-vessel coronary artery disease, offering substantial long-term benefits. Non-cardiac comorbidities such as frailty may significantly affect the outcomes of this procedure. However, the exact impact of frailty on CABG outcomes remains unclear, particularly given its exclusion from many pivotal revascularization trials.
View Article and Find Full Text PDFCVIR Endovasc
December 2024
Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka, 545-8585, Japan.
Background: Fractional flow reserve (FFR) can be estimated by analysis of intravascular imaging in a coronary artery; however, there are no data for estimated FFR in an extremity artery. The aim of this concept-generating study was to determine whether it is possible to estimate the value of peripheral FFR (PFFR) by intravascular ultrasound (IVUS) analysis also in femoropopliteal artery lesions.
Methods: Between April 2022 and February 2023, PFFR was measured before endovascular therapy in 31 stenotic femoropopliteal artery lesions.
Ann Thorac Surg
December 2024
Cedars-Sinai Health System, Los Angeles, CA, USA. Electronic address:
Background: In patients with diabetes and multivessel coronary artery disease, percutaneous coronary intervention (PCI) has been associated with higher long-term cardiovascular mortality compared to coronary artery bypass grafting (CABG), but the specific causes of death are not well known. We aimed to determine the causes of death among patients with diabetes and multivessel disease undergoing coronary revascularization with PCI versus CABG.
Methods: We analyzed the centrally adjudicated causes of death of 1,900 participants in the FREEDOM trial.
J Vasc Surg
December 2024
Department of Vascular Surgery, Red Cross Hospital, Athens, Greece.
Objective: The purpose of this study is to identify variables at the time of clinical presentation which place patients at higher risk for mortality following carotid endarterectomy (CEA) for symptomatic lesions. Further, this study will create a risk score for mortality within two years following CEA for symptomatic stenosis to help tailor future postoperative and long-term management by identifying patients who require heightened vigilance in postoperative care to facilitate survival.
Methods: The Vascular Quality Initiative (VQI) CEA module was queried for procedures performed for symptomatic (within 180 days) carotid bifurcation stenosis.
Radiother Oncol
December 2024
Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
Background And Purpose: Radiotherapy improves outcomes for breast cancer. However, prior studies have correlated the risk of coronary artery disease (CAD) to the mean heart dose (MHD), mean dose to the left anterior descending artery (LAD_mean) and the left ventricle V5Gy (LV5). Other studies showed an increased risk of CAD for patients with pronounced coronary artery calcification (CAC) at the time of radiotherapy.
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